Button, Button, Where's the Button? A Discussion of G-Tubes and
Transcript of Button, Button, Where's the Button? A Discussion of G-Tubes and
“Button, Button. Where’s The Button?” A Discussion of Gastrostomy Tubes
Elizabeth Paton, RN, MSN, PNP, FAEN
OBJECTIVES Discuss History of Gastrostomy Tubes in Pediatrics
List Types of Gastrostomy Tubes
Troubleshoot Basic Problems with Gastrostomy Tubes
Discuss Feeding After G-tube Placement and Formulation of Postoperative CPOE
GASTROSTOMY TUBES IN PEDIATRICS: A BRIEF HISTORY
Surgical placement of gastrostomy tube since 1870s
First Percutaneous Endoscopic Gastrostomy (PEG) Tube was placed June 12, 1979
Laparoscopic gastrostomy since mid 1990s
Other techniques:
Percutaneous radiological gastrostomy (PRG)
Single site laparoscopic gastrostomy
COMPLICATIONS
MAJOR
Peritonitis
Pneumoperitoneum
Colonic fistula/perforation
Bleeding
Obstruction
Failure to insert in stomach
Sepsis
MINOR
Tube dislodgement
Tube blockage
Tube leakage
Tube migration
G-tube site infection
Intussusception
CLOGGED TUBE
Medications that may cause clogging:
Ciprofloxacin
Clarithromycin
Cholestyramine
Iron
Kayexalate
Lactulose
Management:
Flush with 5-10ml warm water
May use “push-pull” technique
GRANULATION TISSUE Keep area dry
Absorptive gauze or foam dressing
Stabilization of tube
Mepilex or Mepilex AG
AgNO3 Stick
Triamcinilone
Excision
HOME GASTROSTOMY SUPPLIES
For MIC-KEY G-tube
MIC-KEY G replacement kit, same size(Fr and cm), 1 now, 4 per year
MIC Secure-Lok extension set 0124-12, 4 per month
60cc catheter-tip syringes- 10 per month if bolus-fed, 2 if continuous feeding
For continuous feedings or intermittent feeds with a pump: feeding pump and appropriate feeding bags, 30 per month
PROPOSED FEEDING REGIMEN Gravity drainage POD 0
POD 1:
Clamp G-tube, check residuals q4 hours X2
If tolerates, and low residuals:
Initiate formula feeds at ¼ of goal, continuous
Increase by ¼ of goal every 6 hours to goal (should be reached in 24 hours)
Nursing communication to include:
Volume of residuals to delay initiation of feeds
Instructions for prn venting
OK to use for medications
Items for notification of MD
POST-OP GASTROSTOMY TUBE ORDERS
Vital Signs
[ ] Vital signs T;N, Temperature,Pulse,Respirations,Blood Pressure every 4 hours
Activity
[ ] Activity as Tolerated T;N, ad lib
Food/Nutrition
[ ] NPO T;N,
Patient Care
[ ] Gastrostomy Tube Care T;N, Gastrostomy tube to gravity
[ ] Nursing Communication T; N: OK to use gastrostomy tube for medications
Respiratory Care
[ ] O2 Sat- Continuous Monitoring (RT) T;N, q2h
Continuous Infusions
[ ] D5 1/2NS KCL 20mEq/L 1000mL,IV,Routine,T:N, at____mL/hr
Medications
[ ] heparin flush 3mL (10 units/mL), injection, IVPush, PRN, routine,T;N, peripheral or central line per nursing policy
[ ] morPHINE _____ mg, (0.1 mg/kg), Injection, IV, q3h, PRN Pain, Routine, T;N
Consults/Notifications
[ ] Dietitian T;N, Reason: Gtube: Enteral feeding management
[ ] Consult Case Management T;N, Reason:Home Gtube supplies
POST-OP DAY 1 GASTROSTOMY TUBE ORDERS
Food/Nutrition
[ ] Tube Feeding Titrate Peds
[ ]
Formula: If child has tolerated clamping of gtube, please start gtube feeds (1/4 of goal volume continuous, increase by 1/4 of goal q6 hours to goal of ___cc/hr)
Patient Care
[ ] Gastrostomy Tube Care T;N, Clamp Gastrostomy tube, measure and record residuals q4 hours
[ ]
Nursing Communication
T;N, If after second check of gtube residuals, residual is less than ___, and child tolerating clamping, please initiate feeds as ordered
[ ] Nursing Communication T;N, Please vent gtube q4 hours and prn gastric bloat, abdominal distention, or wretching
[ ]
Nursing Communication
T;N, If Gtube residual is >hourly volume infused for 2 consecutive hours, please hold feed for 1 hour then resume at previous rate
[ ] Nursing Communication T; N: OK to use gastrostomy tube for medications
Continuous Infusions
[ ] D5 1/2NS KCL 20mEq/L 1000mL,IV,Routine,T:N, at____mL/hr
Medications
[ ] Acetaminophen/Hydrocodone 0.2mg/kg gtube q4h hours prn pain
Consults/Notifications
[ ] Dietitian T;N, Reason: Gtube: Enteral feeding management
[ ] Consult Case Management T;N, Reason:Home Gtube supplies